Individual
MADISON CANARY BASKIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4229 U S HIGHWAY 11, HATTIESBURG, MS 39402-8024
(769) 355-9019
Mailing address
2058 COUNTRY CLUB RD, MCCOMB, MS 39648-5955
(769) 355-9019
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-23-264672
MS
Other
Enumeration date
02/22/2024
Last updated
02/22/2024
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